The electrical T-axis and the spatial QRS-T angle are independent predictors of long-term mortality in patients admitted with acute ischemic chest pain.

OBJECTIVE

To investigate whether the orientation of the electrical T-axis and the spatial QRS-T angle provide independent diagnostic and prognostic information in patients presenting with acute chest pain.

METHODS

Patients with symptoms suggestive of acute cardiac pathology, who were seen by a general practitioner and for whom a prehospital electrocardiogram (ECG) was recorded by the ambulance service between 1992 and 1994 were investigated. The ECGs (n = 2,261) for our study population were stored for off-line analysis by the Modular ECG Analysis System. QRS- and T-axes were computed from the reconstructed vectorcardiographic X, Y and Z leads. During the year 2000, a follow-up of the entire cohort was performed, and the vital status of the patients was determined via the civil registrar's office. Cox multivariable regression analyses were performed to evaluate the relation between the orientation of the T-axis, the spatial QRS-T angle and long-term mortality.

RESULTS

An abnormal orientation of the T-axis and the spatial QRS-T angle were associated with an increased likelihood of cardiac diseases and an increased risk of all-cause mortality during short- and long-term follow-up.

CONCLUSIONS

We conclude that the frontal T-axis and the spatial QRS-T angle are important determinants of diagnosis and prognosis in patients presenting with acute chest pain. The reintroduction of vectorcardiography in routine clinical practice might therefore be reconsidered.